BPH, Prostate and Testicular Cancer Flashcards
What is BPH?
An enlargement of the prostate gland
It develops in the inner portion of the prostate
What are risk factors for BPH
family history environment diet smoking chronic conditions increased weight
What are the obstructive clinical manifestations of BPH
decrease in force of urinary stream
difficulty initiating voiding
intermittency
dribbling at the end of voiding
What are the irrigtative clinical manifestations of BPH
urinary frequency urgency dysuria bladder pain nocturia incontinence
What are complications of BPH
Acute urinary retention
UTI
How do you diagnose BPH?
History and Physical
DRE (distal rectal exam)
PSA
Trans rectal ultrasound (TRUS)
What are the goals for a patient with BPH?
restore bladder drainage
relieve the patients symptoms
prevent or treat complications
Pharmacologically how do you treat BPH?
5 alpha reductase inhibitors PROSCAR (finasteride) Avodart (dutasteride) Alpha adranergic receptor blockers Cardura (doxazosin) Hytrin (terazosin)
What minimally invasive therapy can be done for BPH?
Transurethral microwave thermotherapy
Transurethral needle ablation of prostate
Laser prostatectomy
Intraprostatic urethral stents
What is Transurethral Resection of the Prostate (TURP)?
Removal of prostate tissue
GOLD STANDARD FOR BPH
Bladder irrigation
What occurs during a TURP procedure?
A movable loop is inserted and tissue is removed and coagulated
Irrigation solution carries out debris
Bleeding is common complication
What are pre-op priorities for a TURP procedure?
Assess clotting factors
Qht are post-op priorities for a TURP procedure?
Let them know that clots are normal for 24-36 hours post op
Hematuria is also normal
What is continuous bladder irrigation?
Normal Saline irrigation for 24hrs after a TURP
Adjust irrigation fluid to maintain colorless or pink drainage return
Tape cath to leg to provide gentle traction-ballon at end of catheter is pulled down into prostatic tissue removal area to put pressure on area and maintain hemostasis
What are complications of TURP and CBI?
Potential hemorrhage
depending on how much bleeding; hypovolemia could occur
Bladder spasms- antispasmotics such as oxybutynin (Ditropan)
What does the patient need to know when they go home after having a TURP procedure?
May go home with catheter and need care of indwelling catheter
Increase oral fluids 2 to 3 L
S/S of UTI
Avoid heavy lifting
Driving and sexual intercourse after follow up care with the physician
What are the pre-op goals for a patient having a TURP?
restoration of urinary drainage
treatment of UTI
understanding of procedure
What are the post-op goals for a patient having a TURP?
No complications
Restoration of urinary control
Complete bladder emptying
What is some basic info on prostate cancer?
asymptomatic in the early stages
family history increases risk
eventually may experience symptoms similar to BPH
5 year survival with diagnosis at local stage = 100%
What are clinical manifestations of prostate cancer?
dysuria hesitancy dribbling frequency urgency hematuria nocturia retention inability to urinate
What are late signs of prostate cancer?
Pain in lumbosacral area that radiates to hips or legs when coupled with urinary symptoms, could indicate metastasis
Once cancer has spread to distant sites, pain management becomes a problem
Where can prostate cancer metastasize to?
pelvic lymph nodes
bladder
lungs (SOB)
liver (jaundice, trouble metabolizing drugs, elevated LFTs)
How do you diagnose prostate cancer?
PSA (prostate-specific antigen) blood test
elevated levels indicate prostate pathology, not necessarily cancer
also used to monitor success of treatment
some concern about false positive/negative
levels should decrease after successful treatment
normal level is between 0-4
Digital rectal examination (DRE)
CT
MRI
How can you definitively diagnose prostate cancer
by a biopsy obtained using TRUS (trans-rectal ultrasound)
What are the treatment options for prostate cancer?
surgery chemotherapy radiation hormone therapy watch and wait life expectancy of less than 10 yeaars presence of significant co-morbid condition low-grade, low-stage tumor
What is a radical prostatectomy
The entire gland, seminal vesicles and part of the bladder neck are removed
Retroperineal lymph node dissection usually done
Considered most effective for long-term survival
What are the complications of a radical prostatectomy?
Major complications are ED and urinary incontinence Hemorrhage Urinary retention Infection Wound dehiscence DVT/PE
What are the detail of a nerve-sparing surgical procedure for prostate cancer?
spares nerve responsible for erection
only for cancer confined to prostate
no guarantee potency will be maintained
success is variable
Waht type of therapies can be done for prostate cancer?
external beam brachytherapy implantation of radioactive seed into prostate gland spares surrounding tissue hormonal therapy
What is an orchiectomy?
surgical removal of testes for advanced stages of prostate cancer
reduces circulating testosterone by 90%
helps relieve bone pain with advanced tumors
What are side effects of an orchiectomy?
hot flashes ED loss of libido irritability weight gain loss of muscle mass
What are the outcomes for patients with prostate cancer?
be an active participant in the treatment plan
achieve satisfactory control
follow the therapeutic plan
understand the effect of the treatment on sexual function
satisfactory manage the impact on bowel and bladder function
What is testicular cancer?
relatively rare
most common type of cancer in young men (15-34)
more common in males who have undescended testes
occurs more commonly in the right testicle
most develop from embryonic germ cells
may have slow or rapid onset
may notice lump or swelling in scrotum
mass is typically non-tender and firm
self-exam is vital in detection process
how do you diagnose testicular cancer?
palpation of mass ultrasound AFP HCG LDH
How do you treat testicular cancer?
orchiectomy radical orchiectomy removal of affected testes, spermatic cord and regional lymph nodes radiation chemo fertility issues
